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INFO AND
RESOURCES
Looking For A
Therapist/Psychiatrist
The following
information is from the Sidran organization at sidran.org
and is included
here for reference purposes only.
For further
assistance with this information please contact Sidran.
Therapy for
Post-Traumatic Stress and Dissociative Conditions:
What to Look for and How to Choose a Therapist
One of the primary roles
of Sidran Institute’s Help Desk is to assist people who have been
traumatized in finding various kinds of help. "Treatment" is usually
sought when the behavioral adaptations (usually called "symptoms")
typical of trauma survivors become disabling, interfering with work,
home life, recreation, sleep, parenting, and other aspects of daily
function.
Our aim is not only to help people feel better and function better, but
also to help them learn to be informed and empowered consumers in
general and consumers of mental health services, in particular. We hope
trauma survivors find that taking appropriate and well-considered action
to improve one's life is made a little easier by the information on this
page.
If you are currently in crisis: The process of choosing a
helpful therapist takes some time, thought, and focus. If you are
currently in a crisis, or are worried that you might hurt or kill
yourself or someone else, please contact your community's mental health
center, hospital emergency room, or a hotline. Here are some
hotline numbers that might be useful:
National Suicide Prevention Lifeline: 1-800-273-TALK
National Domestic Violence/Child Abuse/Sexual Abuse: 1-800-799-SAFE
National Youth Crisis Hotline: 800-442-HOPE
When the crisis has passed, this brochure will help you organize the
task of finding a therapist for ongoing treatment.
What Is Good
Trauma Therapy? What Is a Good Trauma Therapist?
Historically, mental health treatment has been treated according to the
"medical model": the "sick" patient treated by the powerful doctor, who
has the responsibility, the expertise, and the tools to cure the
illness. The patient's job is to be compliant and to follow orders. With
some practitioners, this model continues to this day.
Recently, however, some therapy models have come to recognize that
individual distress is often caused or made worse by poor social,
political and economic environments as well as by harmful family
dynamics. Trauma survivors are generally best served by therapists who
work from an environmental framework, or "trauma model," as they are
also more likely to see their clients as experts in their own lives and
as partners in healing.
Later we will look at some of the different disciplines, approaches, and
techniques most appropriate to trauma therapy. Suffice it to say,
however, that good trauma therapists come from every discipline, work in
all settings, use a variety of approaches and techniques, and have a
wide range of credentials and experience.
There are aspects, however, that the best trauma therapists have in
common. We will start by discussing what constitutes good trauma
therapy, and then explore how to find it.
As Dr. Bessel van der
Kolk of Boston University explains, most trauma survivors benefit from
one-on-one psychodynamic therapy. It "allows disclosure of the trauma,
the safe expression of related feelings, and the reestablishment of a
trusting relationship with at least one person."
Therapists do rest much of their practice on the basis of their
professional training. But perhaps as much as anything else, they rest
their practice on their integrity and personal talents—on their
perceptions, feelings, insights, intuition, and the degree to which they
can hear unspeakable truths. "Pay more attention to the
therapist's intellectual and emotional equipment than theoretical
system," Dr. van der Kolk advises survivors. "Pay attention to whether
the therapist really wants to hear the troubles you have to tell. Ask
yourself, 'Do I feel validated? Is the therapist really listening to my
story?'"
If validation is one important selection criterion, Dr. Judith Herman,
Director of Training at the Victims of Violence Program at Cambridge
Hospital in Cambridge, Massachusetts, makes clear a second criterion and
one that seems of equal importance: An effective trauma therapist
empowers the survivor rather than imposes a cure.
The dual formulation of validation and empowerment seems to be
fundamental to post-traumatic therapy.
—Excerpt from Unspeakable Truths and Happy Endings: Human
Cruelty and the New Trauma Therapy, by Rebecca Coffey (Sidran
Institute Press, 1998), pp. 85-86.
The idea of the therapist
and client working together as partners, sharing responsibility and
expertise, is still radical in many mental health settings. But for
trauma survivors, this is in many ways the key to success in therapy.
When treater and client share the trauma perspective they can
collaborate. A shared perspective allows collaboration between the
individual, who has expertise on him or herself (the client), and the
individual who has expertise on the process of healing (the helper).
Helper and client collaborate to identify the central concerns of the
survivor. They work together to improve the survivor's life. Treatment
requires both people's active participation. The trauma model is also an
empowerment model. The helper has useful information to impart, but is
not "the expert" or "the authority" on all matters concerning the
survivor. The client is an important member of his or her own treatment
team, and everyone on the team needs to collaborate to help the client
move forward.
The four most important
things a therapist has to offer a survivor are as follows:
- Respect
- Information
- Connection
- Hope
With these four
components, any relationship can promote healing.
—Excerpt from Risking Connection®: A Training Curriculum for Working
with Survivors of Abuse, by K.W. Saakvitne, L.A. Pearlman, S.J.
Gamble, and Beth Tabor Lev (Sidran Institute Press, 2000), p. 13.
Before You Begin
Although many trauma survivors find it difficult, now would be a good
time to get a complete physical (medical) examination, especially if you
have not had one in the past two years. This is important for at least
three and possibly four reasons:
- Many medical
illnesses (such as thyroid, diabetes, and seizure disorders) might
mask or contribute to mental health conditions and interfere with
appropriate psychological assessment and treatment. It makes sense
to see your physician first to rule out any potential medical causes
of your distress.
- If you are
eventually going to see a psychiatrist for prescribing
antidepressant, anti-anxiety, or other symptom-reducing medications,
the psychiatrist will require a current medical evaluation and will
want to consult with your personal physician.
- Post-traumatic
stress disorder has both psychological and physiological symptoms.
The best way to proceed toward recovery is to attend to medical and
emotional needs in a simultaneous and integrated way. Ideally, your
physician and your therapist should consult periodically about your
progress.
- If you have a
trusting relationship with a family doctor, internist, or general
practice physician, he or she might be a good source of referrals to
a mental health specialist in your community.
Before you actually begin
the process of selecting a therapist, it is important to have a working
knowledge of the range of professional options (and there are many). It
is important to remember that credentials do not necessarily ensure
quality. Still, qualifications are a good starting point in evaluating a
therapist, and should you ever have a harmful therapy experience, you
may have some recourse through a complaint to a licensing body or
professional association.
Types of Mental
Health Care Providers: Alphabet Soup!
The words "therapist" and "counselor" are unregulated, generic terms.
They can be used to refer to anyone providing treatment and can be used
as a title by anyone, with no requirement of special training.
In some states, anyone can hang a shingle on their door and practice
"therapy" with nothing more than a high school diploma, so beware of
"therapists" with unfamiliar titles.
No ethical professional
therapist should mind being asked about his or her educational or
professional backgrounds. You should likely stay away from individuals
who don't have at least a master's degree (e.g., M.S., M.S.W., C.S.W.,
M.A.).
Psychologists
In the United States, Doctors of Philosophy (Ph.D.), Psychology (Psy.D.),
or Education (Ed.D.) must complete at least four years of post-graduate
school, however, only those who have been licensed can call themselves
psychologists. Clinical psychologists are specifically trained in
assessing a client to determine the problem and to respond by providing
treatment. In most states, if medication is needed in addition to
therapy, a psychologist will refer the client to a psychiatrist for that
aspect of treatment.
However, not all psychologists are experienced therapists. Some
specialize in areas such as statistical research or industrial
psychology and may have little experience treating people. Also, don't
assume that Ph.D. always indicates a psychologist. Many people have
earned Ph.D. degrees in unrelated academic fields and may decide to
practice therapy without being clinically trained or licensed.
Social Workers
Clinical Social Workers (CSW) usually have earned at least a master’s
degree (two years of graduate school) and some may have doctoral
degrees. Clinical social workers credentials may vary by state, but
these are the most common:
-
B.S.W. (Bachelor's of Social Work)
-
M.S.W. (Master's of Social Work)
-
A.C.S.W. (Academy of Certified Social Workers)
-
D.C.S.W. (Diplomate of Clinical Social Work).
Although there are
exceptions, most licensed clinical social workers generally have an "L"
in front of their degree (e.g., L.C.S.W.).
Marriage and
Family Therapists and Professional Counselors
Marriage and family therapists (LMFT), and professional counselors (LPC)
may have two years of graduate school and have earned at least a
master’s degree such as:
- M.A. (Master of
Arts)
- M.S. (Master of
Science)
- M.Ed. (Master of
Education).
Marriage and family
therapists have additional specialized training in the area of family
therapy.
Professional counselors, most typically drug or alcohol abuse
specialists—C.A.C. I, II, or III (Certified Addiction Counselors)—may
have a variety of more generalized training in the area of psychology
and counseling. A counselor may or may not have a master's
degree. Counselors are trained for supportive therapy. They usually
focus on behavioral problems not clearly classified as mental illnesses.
Counseling is usually less intensive than psychotherapy.
Other Categories
of Professionals
Many other categories of professionals also provide mental health care
services in private practices or in agencies.
Pastoral counselors are clergy who have the credentials
- M.Div. (Master of
Divinity)
- Th.D. (Doctor of
Theology)
and have a degree from a
seminary or rabbinical school with additional training in therapy.
Psychiatric nurses and nurse practitioners comprise a
growing segment of mental health treatment professionals. They display
the credentials
- R.N. (Registered
Nurse)
- R.N.P. (Registered
Nurse Practitioner)
- M.S.N. (Masters of
Science in Nursing).
A Psychiatric Nurse
Clinical Specialist is a registered nurse with a master's degree who has
been trained in individual, group, and/or family psychotherapy.
Psychiatrists are medical doctors (M.D.s),
who after completing a medical degree like any other physician, follow
up with a four-year psychiatry specialty. Psychiatrists' fees are likely
to be the highest of all mental health providers. In this day of managed
care, psychiatrists rarely provide "talk therapy." It is generally not
necessary for a person with a trauma disorder to use a psychiatrist as a
primary therapist. However, for those who have complex or co-occurring
medical and mental health conditions, a psychiatrist has the advantage
of being a trained M.D. Psychiatrists often work together with other
nonmedical psychotherapists to provide prescription and medication
management services when needed.
The term psychoanalyst refers to any therapist
trained in or practicing in the Freudian or analytic styled
psychodynamic approach.
Hypnotherapist refers to anyone trained in or practicing
hypnosis.
A twelve-step sponsor or a mentor
can provide support for those seeking help, but they cannot take the
place of a psychotherapist.
A 1997 Consumer Reports readers’ survey showed people in
therapy generally rated psychologists, clinical social workers, and
psychiatrists about as equally effective. Marriage counselors were rated
significantly worse, according to patients' rating of their own
improvement.
In general, the most helpful therapists are:
- genuine,
- willing to share
information about themselves as helpful and appropriate,
- have respect and a
high positive regard for their clients,
- are warm and
empathic,
- are responsive and
hopeful,
- have firm boundaries
but are not domineering.
Helpful therapists also
have
- a variety of
clinical skills to address the specific needs of the client;
- an understanding of
the power imbalance that exists in therapy and a willingness to work
toward empowerment of the client;
- a view of the client
as the expert on his or her own life and as an active partner in
therapy.
- awareness of their
own biases and the limits of their skill, and willingness to refer
you to other professionals if necessary.
Consumers of mental
health services have contributed to the following list of things to look
for in a therapist:
- Find a therapist you
feel comfortable with. Therapy is not an easy process and your
therapist is not there to be your friend.
- Find a therapist who
respects your individuality, opinions, and self.
- Find a therapist who
will not get upset if you disagree with what he or she has said, but
instead encourages you to express yourself when you do not agree.
- Find a therapist who
never minimizes your experiences and always respects your feelings.
- Find a therapist who
will not try to force you to talk about things that you might not be
ready for.
- Find a therapist who
does not spend time talking about his or her own problems. Those
sessions are for you, not your therapist.
- Find a therapist who
wants neither a friendship nor a sexual relationship with you
outside of your counseling sessions.
- Find a therapist who
is more than willing to discuss problems that might arise between
the two of you within the therapist/client relationship.
- Find a therapist who
will help teach you new and healthier ways to cope.
- Find a therapist who
will never make you feel like a failure or cause you to believe they
are disappointed in you if you have a slip or a relapse.
Objectives of
Therapy to Address Trauma Issues
Effective psychotherapy for trauma survivors usually involves helping
the survivor maintain safety, manage symptoms, and work through the
traumatic experience(s). While the techniques employed vary, the primary
goals of psychotherapy for trauma survivors are:
- to examine the role
of the traumatic experience in the context of the person's life,
currently and historically
- to make meaning of
the experience
- to learn skills to
manage symptoms and to develop alternative ways of coping
- to build or rebuild
the ability to trust within a relationship in order to view the
world as an increasingly tolerable place to function
There has been a lot of
controversy about therapy that focuses on memories of past trauma.
Because the nature of traumatic stress is to distort memory in a variety
of ways (remembering too much about traumatic experiences or too little,
and in some cases both), therapeutic discussions of the meaning of past
events are important. It is not necessary to use special techniques to
discover hidden memories of violence or abuse. In the course of
addressing problems in current daily function, the opportunity to
discuss past events and the ability to recall them will evolve naturally
as part of therapy.
Types of Therapy
There are many approaches to therapy, and most good therapists are
trained in several and use them in combination. Approaches may be long
or short-term and may be focused primarily on the past or on the
present, but all should aim to alleviate distress and help clients learn
how to acquire more effective coping strategies.
Psychodynamic approaches attempt to help the client discover the
origins of the problem in the past as well as how it affects life today.
A behavioral approach tends to focus on changing current
behavior with little emphasis on past events. The cognitive
approach focuses on changing the client's way of thinking, and a family
systems approach aims to change unhelpful patterns in families.
Formats for therapy include individual (or one-on-one) therapy, couples'
therapy, family therapy, and group therapy. Some therapists use a
combination of these formats.
Today, many therapists
describe their work as eclectic, meaning that they draw from a
wide variety of approaches in order to best meet the needs of each
individual client. Research indicates that the quality of the
therapeutic relationship is often more important than the particular
methods employed. In therapy for traumatic stress, the relationship is
particularly important, as rebuilding interpersonal trust is often a key
objective of treatment. The most important thing to remember is that
your needs are paramount; choose a therapist whose approach seems most
appropriate for you.
Getting
Referrals
You can begin the process by getting referrals. REMEMBER: when choosing
a therapist, you are a consumer of service, and it is your right to shop
around.
Your family doctor
may be able to make a referral for you, although doctors may not know
therapists who have particular experience with trauma survivors. Sidran
Institute has a list of therapists around the world who have made a
commitment to addressing the needs of trauma survivors. We would be
happy to provide names of therapists in
your area from which you can choose.
Referral agencies or a women's resource center in your area may also be
able to assist you in your search. Some insurance companies require that
you choose from a list of preapproved therapists in your area.
You might also ask people you know who've been in therapy to make
recommendations. A therapist who's right for someone else may not be
right for you, but someone you trust who has actually worked with a
particular therapist can share very helpful information.
Once you have made inquiries, make a list of names of two or three
therapists from whom to choose.
The Interview
When interviewing a potential therapist, keep in mind your needs and
goals for therapy, as well as the particular qualities you feel are
important in a therapist. We often hear about the need for a "match"
when selecting a therapist and there is a lot to be said for feeling
comfortable with the person you choose. Although your objective is not
to build a friendship with the therapist, you will be spending a lot of
time together, and you will need to feel comfortable enough to discuss
sensitive, confidential thoughts and feelings.
Below you will find a list of questions that may help you interview
helpers to determine who suits your needs the best. You may find it
helpful to take this list with you on interviews along with a pad of
paper to record your information.
Questions:
- What are your
credentials?
- What are your
specialties?
- What professional
organizations to you belong to?
- How long have you
been conducting therapy?
- What experience have
you had in treating traumatic stress conditions?
- How do you approach
treatment of traumatic stress conditions?
- What do you charge?
- Do you accept
insurance? If so, what kinds?
- Do you have a
sliding fee scale? If so, how is payment determined?
- Do you bill people,
or is payment expected at the time of the session?
- How do you protect
client confidentiality? Who (besides you) will have access to my
files?
- How long is each
session? Are there exceptions to this?
- Has anyone ever
lodged a formal complaint against you?
- Have you ever been
censured by a professional organization?
- If I were in crisis,
would I be able to reach you? How do you handle crises?
- What is your policy
about missed sessions?
- What is your policy
about physical contact with clients?
- What is your policy
about contact outside of the session?
- Do you arrange
vacation coverage?
- What happens if one
of us decides to terminate without the other's agreement?
- Do you think you can
help me?
- Is there anything I
should know about your services that I didn't think to ask about?
My impressions: check all
that apply
- I felt safe and
reasonably comfortable
- I felt understood
and taken seriously
- I was treated
respectfully
- We agreed about the
nature of the problem
- This feels like it
could be a good "match"
- My questions were
answered adequately
- My treatment goals
were addressed
- This individual is
clinically qualified
- I can afford it
- I can get there with
reasonable ease
Overall impression:
Don't forget (or avoid)
talking about money. You need to know before you start how you are going
to pay for treatment. Therapists may take a variety of insurance
payments: private insurance, Medicare, or state medical assistance;
others will offer a payment plan or work on a sliding scale, based on
what a client can afford. Rarely, a therapist may offer to do "pro bono"
work (treat one or a few clients at no charge). As appealing as this may
seem, it is not really a good idea, and may under some circumstances be
unethical. This dynamic reinforces the power imbalance that is inherent
in the therapy relationship, and the client may come to feel the "debt
owed" interferes with therapy.
After the first meeting with the potential therapist, you will need to
ask yourself some questions:
- Did you feel
comfortable and able to begin discussing your problems?
- Did the therapist
seem to understand what you were talking about?
- Did you feel your
concerns were taken seriously and that you were treated with
respect?
- Were the two of you
in general agreement about the problem and your expectations for
therapy?
- Were you satisfied
with the therapist's answers to your questions?
- Did you feel that
you could grow to trust and work with this person?
Pay attention to your
intuition; choosing a helpful therapist will require trusting your own
thoughts and feelings. Remember that you are a consumer of a service and
that it is your right to choose a therapist who best meets your needs.
Taking Stock
Throughout the course of therapy, you will need to be mindful that your
work is productive and continues to be helpful. In helpful therapy
relationships, the client feels understood and supported, and while
therapy is not always a comfortable experience, there should be a sense
of trust and warmth.
If you don't feel respected, valued, or understood, or if your
experience is being minimized or distorted, it may be a sign that your
therapy is not working. If you feel there is something wrong in your
therapy, or if you get upset or angry with your therapist, discuss it in
your session. If your therapist discounts your feelings or responds in a
defensive manner, you can choose to switch to a different, more
respectful therapist.
If you are working with a helpful therapist, you will begin to be able
to better recognize and understand your feelings, thoughts, and
behaviors. You will also begin to develop new, more effective coping
strategies, and you should have a sense of change and increased
satisfaction in your life. Over time, you should begin to feel more and
more independent and able to use the skill and insights you are learning
in therapy to solve your own problems.
Disclaimer:
This site contains information to be used only for the purpose of
support and general education. It should not be used for diagnosis
and/or treatment of any physical or mental conditions. It is owned,
designed
and maintained by a healing survivor in recovery. The author of the
general text is the owner and that general text remains the property of
said owner. Other materials used on the site come from various authors
and will have the author credited and those materials remain the
property of said authors with copyright information included when and
where it is available.
We assume no liability for the contents or effects of this site. Some of
the content may be disturbing. Read at your own risk. If you believe you
are suffering from a physical or mental condition seek help from a qualified professional physician, psychiatrist,
psychologist or therapist; a crisis center; or call 911.
Recommended Online Support Group
for
those who have been diagnosed with DID
and are in treatment for healing with a professional,
and for those professionals who treat those with DID:
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